Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Click here to browse AJSM online!

Sign In to gain access to subscriptions and/or personal tools.
Medical Decision Making
This Article
Right arrow Full Text (PDF)
Right arrow References
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Tsevat, J.
Right arrow Articles by Pauker, S. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tsevat, J.
Right arrow Articles by Pauker, S. G.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Warfarin for Dilated Cardiomyopathy

A Bloody Tough Pill to Swallow?

Joel Tsevat, MD, MPH

Mark H. Eckman, MD

Robert A. Mcnutt, MD

Stephen G. Pauker, MD

Although current recommendations for the treatment of dilated cardiomyopathy include long- term anticoagulation to diminish the likelihood of systemic embolization, there have been no clinical trials examining the effectiveness of anticoagulation in preventing systemic emboli zation in these patients. Furthermore, those recommendations do not address the issue of the quality of life associated with long-term warfarin therapy. Using decision analysis, the authors examined the benefits and risks of long-term anticoagulation for patients 35 to 75 years of age who have dilated cardiomyopathy. The results show that anticoagulant therapy increases quality-adjusted life expectancy by 76 to 128 days, depending on the patient's age. Sensitivity analysis, however, demonstrates that the outcome is dependent on the disutility associated with long-term warfarin therapy. Interestingly, anticoagulation exerts most of its benefit by preventing pulmonary embolization, not systemic embolization. The authors conclude that the current recommendation to anticoagulate these patients, although probably correct for many patients, should take into consideration the change in lifestyle imposed by long-term anticoagulant therapy. For some patients, the benefit may not outweigh the sac rifice.

Key Words: Key words: anticoagulation • dilated cardiomyopathy • warfarin • decision analysis • quality of life. (Med Decis Making 1989;9:162-169)

Medical Decision Making, Vol. 9, No. 3, 162-169 (1989)
DOI: 10.1177/0272989X8900900303
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Management ScienceHome page
G. Hazen
Preference Factoring for Stochastic Trees
Management Science, March 1, 2000; 46(3): 389 - 403.
[Abstract] [PDF]

Home page
 JAMAHome page
G. Guyatt
A 75-Year-Old Man With Congestive Heart Failure
JAMA, June 23, 1999; 281(24): 2321 - 2328.
[Full Text] [PDF]

Home page
 JAMAHome page
W. S. Richardson, A. S. Detsky, the Evidence-Based Medicine Working Group, G. Guyatt, D. Cook, H. Gerstein, R. Hayward, A. Holbrook, R. Jaeschke, E. Juniper, et al.
Users' Guides to the Medical Literature: VII. How to Use a Clinical Decision Analysis B. What Are the Results and Will They Help Me in Caring for My Patients?
JAMA, May 24, 1995; 273(20): 1610 - 1613.
[Abstract] [PDF]

Home page
 JAMAHome page
W. S. Richardson, A. S. Detsky, and the Evidence-Based Medicine Working Group
Users' Guides to the Medical Literature: VII. How to Use a Clinical Decision Analysis A. Are the Results of the Study Valid?
JAMA, April 26, 1995; 273(16): 1292 - 1295.
[Abstract] [PDF]

Home page
 JAMAHome page
D. W. Baker and R. F. Wright
Management of Heart Failure: IV. Anticoagulation for Patients With Heart Failure Due to Left Ventricular Systolic Dysfunction
JAMA, November 23, 1994; 272(20): 1614 - 1618.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
G. B. Hazen
Factored Stochastic Trees: A Tool for solving Complex Temporal Medical Decision Models
Med Decis Making, August 1, 1993; 13(3): 227 - 236.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
I. G. Naglie and A. S. Detsky
Treatment of Chronic Nonvalvular Atrial Fibrillation in the Elderly: A Decision Analysis
Med Decis Making, December 1, 1992; 12(4): 239 - 249.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
G. B. Hazen
Stochastic Trees: A New Technique for Temporal Medical Decision Modeling
Med Decis Making, August 1, 1992; 12(3): 163 - 178.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
B. E. Hillner, J. T. Philbrick, and D. M. Becker
Optimal Management of Suspected Lower-Extremity Deep Vein Thrombosis: An Evaluation With Cost Assessment of 24 Management Strategies
Arch Intern Med, January 1, 1992; 152(1): 165 - 175.
[Abstract] [PDF]

Home page
 Arch Intern MedHome page
T. R. Lancaster, D. E. Singer, M. A. Sheehan, L. B. Oertel, S. W. Maraventano, R. A. Hughes, and J. P. Kistler
The Impact of Long-term Warfarin Therapy on Quality of Life: Evidence From a Randomized Trial
Arch Intern Med, October 1, 1991; 151(10): 1944 - 1949.
[Abstract] [PDF]

Home page
 Med Decis MakingHome page
R. S. Dittus
Navigating through the Turbulence in Health Care
Med Decis Making, August 1, 1989; 9(3): 155 - 156.
[PDF]